Program Director/Principal Investigator (Last, First, Middle): Hohmann, Lindsey A Abstract Background & Significance: Given the rising problem of prescription drug abuse & high number of opioid-related deaths annually in the United States, mechanisms to distribute naloxone (a fast-acting opioid reversal agent) are sorely needed. Due to extended hours & no need for appointments, community pharmacies offer a solution. Since 2015, all 50 states have passed bills allowing pharmacists to dispense naloxone to patients without a physician?s prescription. However, pharmacists still miss opportunities to dispense naloxone to eligible patients due to misinformation or lack of confidence in implementing naloxone services. Aims: The purpose of this study is to create & assess a targeted pharmacist training program for naloxone therapy management to increase community pharmacists? knowledge, attitudes, confidence, intention, & naloxone dispensing activities for prevention of opioid overdose deaths. This study will use mixed methods & a 2-group pragmatic randomized controlled trial design among community pharmacists in Alabama to address two specific aims: 1) to incorporate community pharmacists? training needs & experts? strategies to overcome barriers regarding pharmacy-based naloxone services implementation into the development of a targeted training program; & 2) to evaluate a targeted naloxone training program among community pharmacists. Methods: A 2-stage participatory design approach will be employed consisting of: 1) formative interviews with Alabama community pharmacists & opioid/naloxone experts; & 2) stakeholder panel. Formative interviews have been completed & qualitatively analyzed to determine pharmacists? needs & experts? strategies. These needs & strategies will inform development of a training program using a Delphi process of iterative feedback & modification with a panel of pharmacists? & experts to assess the feasibility, acceptability, and usability of training content & format. After the program is finalized, Alabama community pharmacists in counties with high opioid death rates will be invited to participate using a combination of mail, email, & phone recruitment & randomized to control (no training) or intervention (training) group. The training?s impact on pharmacists? knowledge, perceived barriers, attitudes, confidence, & intention to implement naloxone services will be assessed via online surveys at baseline, immediately post-training, & 3 months. Self-reported naloxone service implementation and dispensing behaviors will be measured at baseline and 3 months. Mean differences between groups across time-points will be assessed using mixed ANOVA, with associations between implementation behaviors, knowledge, beliefs, & intentions assessed via GEE models with log-link function. Implications: Pharmacists? knowledge, confidence, intention, & implementation of naloxone dispensing activities are expected to increase, suggesting that training programs created via a participatory design approach are an effective method to increase capacity of trained providers & improve patient access & safety. 1